Shalev E, Yarom I, Bustan M, Weiner E, Ben-Shlomo I
Department of Obstetrics and Gynecology, Haemek Medical Center, Afula, Israel.
Fertil Steril. 1998 Jan;69(1):62-5. doi: 10.1016/s0015-0282(97)00425-1.
To evaluate the efficacy of transvaginal sonography and serum beta-hCG levels as diagnostic tools for deciding whether to perform operative laparoscopy in the treatment of presumed ectopic pregnancy (EP).
A prospective protocol for the evaluation and treatment of women with presumed EP.
Department of Obstetrics and Gynecology, Haemek Medical Center, Afula, Israel.
PATIENT(S): Eight hundred forty women with presumed EP who were seen in our emergency department from January 1988 through December 1995.
INTERVENTION(S): On the basis of specific sonographic signs and beta-hCG levels, we performed immediate operative laparoscopy in patients with demonstrable extrauterine fetal heart activity or >100 mL of fluid in the pelvic cavity. We followed up all other patients, using defined criteria for laparoscopic intervention.
MAIN OUTCOME MEASURE(S): The accuracy of transvaginal sonography in predicting EP was evaluated as part of the described protocol.
RESULT(S): Overall, 380 patients were found to have EP. Of these, 331 were identified positively by transvaginal sonography and 49 were not. In 27 of 358 laparoscopies, no EP was found. The sensitivity of transvaginal sonography for the prediction of EP was 87% and the specificity was 94%. The positive and negative predictive values were 92.5% and 90%, respectively.
CONCLUSION(S): In this protocol, which invariably captured the true location of the products of conception, using transvaginal sonography as the primary modality in the evaluation of patients with presumed EP resulted in the use of laparoscopy mainly as a treatment tool. This approach is both safe and economical.
评估经阴道超声检查及血清β - 人绒毛膜促性腺激素（β - hCG）水平作为诊断工具，用于决定在疑似异位妊娠（EP）治疗中是否进行腹腔镜手术的疗效。
一项针对疑似EP女性的评估与治疗的前瞻性方案。
以色列阿富拉海梅克医疗中心妇产科。
1988年1月至1995年12月期间在我院急诊科就诊的840例疑似EP女性。
根据特定的超声检查体征和β - hCG水平，对于有可证实的宫外胎儿心跳活动或盆腔内有>100 mL液体的患者，我们立即进行腹腔镜手术。我们对所有其他患者进行随访，并使用明确的腹腔镜干预标准。
作为所述方案的一部分，评估经阴道超声检查预测EP的准确性。
总体而言，380例患者被确诊为EP。其中，经阴道超声检查阳性确诊331例，未确诊49例。在358例腹腔镜检查中，27例未发现EP。经阴道超声检查预测EP的敏感性为87%，特异性为94%。阳性预测值和阴性预测值分别为92.5%和90%。
在本方案中，该方案始终能确定妊娠产物的真实位置，将经阴道超声检查作为评估疑似EP患者的主要方式，使得腹腔镜检查主要用作治疗工具。这种方法既安全又经济。
